Thread by @DBrozeLiveFree

Judge Chen has taken the bench and Day 2 of phase 2 of the #FluorideLawsuit has begun. Follow me for the next 5 hours.

Fluoride Action Network Attorney Michael Connett calls first witness, Dr. Bruce Lanphear.

Bruce Lanphear is a public health physician &pediatric epidemiologist that specializes in environmental exposures including lead & other toxic chemicals. Dr. Lanphear has an M.D. from the University of Missouri at Kansas City and an M.P.H. from the Tulane School of Public Health

FAN Connett says they want to hear from Dr. Lanphear regarding his work on lead and IQ.

FAN Connett: What is the principal study that the EPA based their lead regulation on?

Lanphear: they relied on many studies, but the key one is the pooled analysis (conducted by Lanphear himself).

EPA objects to the line of questioning for relevancy. Judge over rules.

Connett: Did your pooled analysis on lead and IQ include any new data that had not been previously published?

Lanphear: yes, it included a study I conducted that had not been published and we decided to include it in the pooled analysis bc it was relevant to the research.

Connett: When the EPA relied on the pooled analysis did they make any comment about you including new data as part of the pooled analysis?

Lanphear: No, not as far as I know.

Connett: we previously talked about your advisory work for the EPA relating to lead, since the first phase of the trial have you done additional work for the EPA?

Lanphear outlines several positions he is currently holding as an advisor relating to lead toxicity.

Connett asks Lanphear about his recent contribution to a World Bank report, asks him to explain.

Lanphear says his research found that lead was the leading cause of cardiovascular disease in the U.S., and the World Bank used his research in their report.

Connett moves to discuss Lanphear's work on fluoride. Asks Lanphear to outline his involvement of the MIREC birth cohort study on fluoride.

Connett: at the first trial you testified on the Green (2019) and Till (2020) studies you were involved in. Subsequent to the last trial have you conducted any further studies?

Lanphear: yes

Connett: lets start by summarizing what you did for the first two studies.

Lanphear: for the first study (*Till, 2018) we examined water fluoridation and urine levels, as well as creatinine levels.

Connett lets focus on Green, 2019 study. Asks Lanphear if he did anything after the study was completed to make sure the statistical analysis was correct.

Lanphear: the study underwent peer review, multiple peer reviews, 3 separate investigators pore over the data bc we understand it would have implications for public health policy.

Connett: you say they independently verified the findings? What does that mean?

Lanphear: They all had a data set and examined them separately and independently to verify the data and look for results.

Connett: you mentioned this was one of the most peer reviewed study you experienced. how many studies have you published?

Lanphear: about 350.

Connett: Let's talk about the MIREC cohort. how would you describe the demographics and socioeconomic status of the women studied?

Lanphear: it was mostly urban, Canadian women, tended to be more middle class, affluent women than representative of typical Canadians.

Connett: what are the implications if you are absorbing a chemical and not able to excrete through your urine or other means?

Lanphear: it could built up and have toxic effects if someone is not able to expel the chemical through the kidneys.

Connett: asks if Lanphear controlled for seafood in one analysis. Lanphear says no but he is aware seafood can contain fluoride.

Connett: why didnt you control for seafood?

Lanphear: we didnt worry especially about it bc we didnt think there was high seafood consumption

Lanphear: we went to the water treatment plants that supplied the women in the study with their water. They took samples from the water treatment and lined those up with the women by their postal codes.

Connett: can you summarize the Green study?

Lanphear: after adjusting for covariants we found that water fluoride was associated with a reduction of IQ in boys, but not girls.

Connett asks Lanphear about EPA's statement yesterday that his study didnt find association with lower IQ in girls...

Judge Chen interrupts and asks for clarification by Lanphear about previous study and impact on women.

Lanphear explains that his study found an association with fluoride exposure and a reduction of IQ in boys and girls, but not specifically through water fluoridation.

Connett asks Lanphear if he can describe to the court how they interrogated the dose-response relationship in the MIREC cohort.

Connett based on your analyses, did you find in the MIREC cohort that there was a linear, dose-response relationship?

Lanphear: yes

Connett: did you establish a threshold for where you saw the linear, dose-response relationship?

Lanphear: we were careful about how we approached this, with a linear relationship there was no real reason to search for the threshold.

Lanphear: I was taught to think linearly, but what we found was that you actually see affects on the IQ at the lower levels of lead. He explains that they found impacts at lower levels but it started to flatted out at the higher doses of lead.

Lanphear: This is the same dilemma we had with lead, over the last 50 yrs the level of lead has been decreasing bc of regulation until 2012 when the EPA found that there was no safe amount of lead. We dont have a complete control population for lead, and for fluoride.

Connett: can you explain to the court what you mean by a "complete control population for fluoride"?

Lanphear explains that we have numerous exposures to fluoride so the levels of fluoride are ubiquitous.

Lanphear: If we wanted to ask the question, is there a difference in children who are unexposed to fluoride, well we really cant find children who are not exposed to fluoride.

Connett: does that make it harder to see the differences in fluoridated and non-fluoridated children?

Lanphear: when we pooled our data together it all became clear, that differences in IQ impacts, were because of variation in exposures to fluoride.

Connett: After completing the Green study on IQ, you worked on the Till 2020 study on baby formula relating to fluoride. Was the babys consumption of formula with fluoridated water associated with lower IQ later in life?

Lanphear: yes.

Lanphear confirms they found impacts on IQ for boys and girls in the Till, 2020 study.

Connett: do you think the MIREC cohort of relatively well off families will capture the full range of fluorides impacts across the population?

EPA objects, judge over rules. Lanphear: no.

Lanphear: it certainly doesnt capture the full range of vulnerabilities.

Connett: is there any reason to believe that those who live in low income communities will be more susceptible to harms of fluoride?

EPA objects for foundation, Judge agrees. Connett restarts questioning

Connett rephrases the question, establishes foundation, and asks again if folks in poorer areas will be more impacted by fluoride. EPA objects again, judge over rules.

Lanphear discusses how studies have found that children in poorer areas were often more exposes to toxins.

Lanphear: relating to the MIREC study, knowing that fluoride impacts the thyroid, there's "kinda like a 3-hit method", pregnancy impacts the thyroid, along with fluoride, and a reduction in iodine - those were the women we saw a picture of hypothyroidism.

Lanphear explains why his team looked at thyroid disruption as it relates to fluoride, PFAS, and other known toxins.

He notes that there are many toxins that impact the thyroid but they wanted to specifically see how fluoride might impact it as well.

Connett asks for clarification that Lanphear said that when studying PFAS individually they didnt see the same impacts on the thyroid.

Lanphear: with one stressor we didn't see impacts, but with 3 we did"

Judge Chen asks for clarification if Lanphear's study looked at fluoride and thyroid.

Lanphear explains that there is evidence that fluoride appears to impact the thyroid and IQ if a pregnant mother has less iodine available.

Judge Chen asks Lanphear to explain statements made yesterday about measuring verbal and non-verbal impacts on IQ.

Lanphear: we want to investigate what appears to make children vulnerable.

Connett continues questioning..

Connett: are there any other studies you are aware of that have found impact on non-verbal IQ on children other than yours?

Lanphear mentions another study, says they were testing diet intake for fluoride exposure.

Lanphear: they used a different measure with children but what you are measuring is non-verbal impact and they found it when testing for diet intake.

Connett mentions this other study (cant quite hear the name) and statements by the EPA yesterday which attempted to downplay the impact on children.

Lanphear explains how this study (which EPA downplayed) is credible, and did find lower IQ.

EPA objects and tells judge weve been hear almost an hour and we havent heard about the 2 studies the witness testified on. Judge Chen over rules allows questioning to continue.

Connett: Can you explain to the court why there is interest in iodine and fluoride intake?

Lanphear: I mentioned that in the 2006 NRC research they recognized that fluoride is a thyroid disruptor. It is likely to be worse in those with low iodine.

Lanphear explains that we still dont know the mechanism that causes lead to lower IQ and you dont need to know to act.

Connett: are you aware of any other medical uses in history for fluoride besides dental health?

Lanphear explains there is a history of using fluoride to lower hyperthyroidism.

Connett: does this mean the population in general could have their thyroid impacted?

Lanphear: yes

Connett brings up this study and is asking witness Dr. Bruce Lanphear about his involvement on the research:

Iodine Status Modifies the Association between Fluoride Exposure in Pregnancy and Preschool Boys' Intelligence

pubmed.ncbi.nlm.nih.gov/35889877/

As Lanphear is explaining, EPA interrupts and says the study on screen was not submitted to the court. Connett responds he was just trying to show the study to the court. Judge Chen asks him to take it down.

Connett asks Lanphear to explain the mechanism of how fluoride impacts the thyroid and can displace iodine.

Lanphear: its bc of the competition between fluoride and iodine that there could be some interruption to the thyroid.

Judge Chen asks for clarification, Lanphear says fluoride could interfere with iodine production.

Connett: can you discuss the sex-specific nature of what you found in the Goodman, 2022 study?

Lanphear: This provided partial explanation for why we might be finding more of an impact with boys. Boys who have insufficient iodine during development have an even greater impact.

Connett asks Lanphear what is ideal for determining fluoride impact on iodine. Lanphear says ideally you would have a full year of urine samples but thats not necessary.

Lanphear the fact that we saw what we saw in the study is a type of validation.

Connett asks Lanphear about the U.S. population and issues with iodine.

Lanphear: Iodine deficiency has been increasing in the United States.

Connett asks Lanphear about his 2023 study, Fluoride exposure and hypothyroidism in a Canadian pregnancy cohort.

pubmed.ncbi.nlm.nih.gov/36764861/

Connett: was this study funded by the NIH? Lanphear confirms. Connett asks what they were looking for.

Lanphear explains that fluoride could also be disrupting the thyroid in the pregnant mother. We know about "Cretinism" or Congenital iodine deficiency syndrome.

Connett: is there any dispute that hypothyroidism can lead to lower IQ?

Lanphear: no

Lanphear mentions previous study done by Stephen Peckham relating to fluoride and hypothyroidism.

I believe its this one: jech.bmj.com/content/69/7/6…

Lanphear explains why they believe using urinary fluoride measures but also says the downsides is bc of fluoride's half life so they are only seeing some of the impact.

If we want to ask questions about health impact of fluoride we want to look at our options.

Lanphear: Fluoride is kinda like a steady day after day exposure. The urinary fluoride is going to be fluctuating.

Fluoride intake is going to be somewhere in the middle. We try to account for all of the various fluoride intake.

Connett: can you describe to the courts your findings?

Lanphear: we saw significant increase in water fluoride exposure and hypothyroidism.

Connett: how many women were involved in your analysis of fluoride and hypothyroidism?

Lanphear: over 1,000

Lanphear: we found even stronger associations with fluoride exposure and impact on the thyroid in women who didnt have this specific antibody.

Connett asks Lanphear if this might impact the ability to observe the impacts of fluoride depending on if women had this antibody or not.

Lanphear provides his answer, EPA moves to strike on "speculation", Judge Chen over rules.

Judge Chen asks Lanphear to further explain his statements about the differences in exposure relating to the various methods of fluoride exposure. Lanphear explains the cumulative impact of fluoride exposure on the body.

Judge Chen: you would expect to see some correlation between water fluoridation and urinary fluoride measures.

Lanphear explains that urinary fluoride during pregnancy is just a snapshot of time, but water fluoridation exposure is constant and ongoing.

Judge Chen asks if the studies account for people who drink bottled water. Lanphear says they only studied women who drank tap water.

Chen is curious about how many people were excluded bc they didnt drink tap water. Lanphear doesnt remember the number.

Connett: subsequent to the 1st phase of this trial, have any further research been published to support a sex-specific effect of fluoride on neurodevelopment?

Lanphear: mentions a group in Cincinnati, Atkins study(?), and this research also found impacts on boys IQ.

Lanphear says there were internal and external impacts on IQ observed.

Connett asks if results from two studies - which show impacts on only boys and one on boys & girls - could both be correct. EPA objects, judge over rules.

Lanphear says yes, even if we dont know why.

Connett: in your opinion, will a neurotoxicant show different impacts upon different populations?

Lanphear: We're always leaning, with the fluoride and the MIREC study, we found that we need to start looking at fluoride and iodine if we want to understand the impact more fully.

Connett prepares to close by asking Lanphear about the Till, 2018 study. Shows Lanphear a graph and asks him to explain.

Lanphear: this is a graph of the 3rd trimester of pregnant mothers, looking at the 50th percentile, 75th, and 95th.

Lanphear says that the urinary fluoride concentrations are about twice as high as average exposure.

Connett asks Lanphear to look at the 95th percentile of pregnant women in 3rd trimester.

Pregnant women show 2.41 mg/L and the non-fluoridated show 1.04 mg/L.

Connett asks if there is anything else he can think of that would account for this difference.

Lanphear says no, other than water fluoridation.

Judge Chen asks questions relating to Canadian measures of water fluoridation.

Connett: At your deposition you were asked a hypothetical about how you would treat 2 different studies with different outcomes. EPA objects for scope about hypothetical, judge over rules.

Now there is some back and forth about whether Connett can ask a hypothetical.

Connett asks Lanphear what he thinks about 2 studies showing an association and 2 studies not showing association.

Lanphear says he doesnt remember what he said before, but there is ample evidence leaning towards an association. "you dont want to ignore all this evidence"

Lanphear says you collect all high quality studies even when they conflict, and study their methodologies, exposure methods.

When you have all this evidence, what you really want to do is try to understand why they're different.

Lanphear: its not really just about 2 studies vs 2 studies, but dig deeper into the methods and ask more specific questions.

Connett ends his questioning of witness. Court goes into 1st recess. Will resume with EPA cross examination of Dr. Bruce Lanphear.